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Physiotherapy Mar 2017Age-related changes in the trunk (abdominal and lumbar multifidus) muscles and their impact on physical function of older adults are not clearly understood. (Review)
Review
BACKGROUND
Age-related changes in the trunk (abdominal and lumbar multifidus) muscles and their impact on physical function of older adults are not clearly understood.
OBJECTIVES
To systematically summarise studies of these trunk muscles in older adults.
DATA SOURCES
Cochrane Library, Pubmed, EMBASE and CINAHL were searched using terms for abdominal and MF muscles and measurement methods.
STUDY SELECTION
Two reviewers independently assessed studies and included those reporting measurements of abdominal muscles and/or MF by ultrasound, computed tomography, magnetic resonance imaging or electromyography of adults aged ≥50 years.
DATA SYNTHESIS
A best evidence synthesis was performed.
RESULTS
Best evidence synthesis revealed limited evidence for detrimental effects of ageing or spinal conditions on trunk muscles, and conflicting evidence for decreased physical activity or stroke having detrimental effects on trunk muscles. Thicknesses of rectus abdominis, internal oblique and external oblique muscles were 36% to 48% smaller for older than younger adults. Muscle quality was poorer among people with moderate-extreme low back pain and predicted physical function outcomes.
LIMITATIONS
Study heterogeneity precluded meta-analysis.
CONCLUSION
Overall, the evidence base in older people has significant limitations, so the role of physiotherapy interventions aimed at these muscles remains unclear. The results point to areas in which further research could lead to clinically useful outcomes. These include determining the role of the trunk muscles in the physical function of older adults and disease; developing and testing rehabilitation programmes for older people with spinal conditions and lower back pain; and identifying modifiable factors that could mitigate age-related changes.
Topics: Abdominal Muscles; Age Factors; Aged; Aged, 80 and over; Aging; Exercise; Female; Humans; Low Back Pain; Lumbosacral Region; Male; Middle Aged; Paraspinal Muscles; Rectus Abdominis; Sex Factors; Stroke; Torso
PubMed: 27667760
DOI: 10.1016/j.physio.2016.06.001 -
The Spine Journal : Official Journal of... Oct 2020Lumbar disc herniation (LDH) is one of the most often diagnosed degenerative pathologies within the lumbar spine. Paraspinal muscle involvement could be a possible... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Lumbar disc herniation (LDH) is one of the most often diagnosed degenerative pathologies within the lumbar spine. Paraspinal muscle involvement could be a possible mediator in the pathophysiology of disc herniation and influences the course of pain and disability after both surgical or nonsurgical treatment. To potentially improve treatment, it may be important to assess multifidus muscle morphology in patients diagnosed with a LDH.
OBJECTIVE
A systematic literature review and meta-analysis regarding the multifidus morphology in patients diagnosed with a LDH was conducted to assess the differences in multifidus muscle morphology between persons with LDH and healthy controls, and between the involved and the uninvolved side within subjects experiencing unilateral LDH.
METHODS
A systematic search was conducted of articles published up to and including November 2019 using the Pubmed, Web of Science, EMBASE, and MEDLINE Ovid search engines. The articles obtained from this search were screened based on title and abstract using the predetermined eligibility criteria. Included full text articles were assessed for their methodologic quality using the modified Downs and Black checklist. Heterogeneous data regarding multifidus muscle morphology was included in the descriptive analysis; data that was homogenous was included in the meta-analysis.
RESULTS
We identified 3,176 articles. Based on the screening for inclusion/exclusion criteria, 18 articles were included. Studies were either cross sectional or case-control studies assessing side-to-side differences or comparing patients diagnosed with a LDH to a healthy control group. Nine studies investigated whole muscle atrophy, six looked at muscle fat infiltration, seven studies assessed microscopic muscle properties including muscle fiber size, distribution, and muscle fibrosis. From the 18 articles, 10 were included in the meta-analysis. In the meta-analysis, a comparison was made between side-to-side differences for muscle fiber size, distribution, and whole muscle size. Descriptive analysis showed increased fat infiltration and atrophy (muscle and individual fiber) of the multifidus muscle when comparing side-to-side differences or comparing cases to controls. Meta-analysis showed a significant decrease in type I and II muscle fiber size (p=.002, .01, respectively) combined with a significant increase in the number of type I muscle fibers (p=.008) at the side of LDH. Regarding whole muscle size, no significant differences were found.
CONCLUSIONS
This study shows the presence of ipsilateral multifidus muscle changes in persons with unilateral LDH.
Topics: Cross-Sectional Studies; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Lumbar Vertebrae; Paraspinal Muscles
PubMed: 32325246
DOI: 10.1016/j.spinee.2020.04.007 -
The Spine Journal : Official Journal of... 2001The notion that headaches may originate from disorders of the cervical spine and can be relieved by treatments directed at the neck is gaining recognition among headache... (Review)
Review
BACKGROUND CONTEXT
The notion that headaches may originate from disorders of the cervical spine and can be relieved by treatments directed at the neck is gaining recognition among headache clinicians but is often neglected in the spine literature.
PURPOSE
To review and summarize the literature on cervicogenic headaches in the following areas: historical perspective, diagnostic criteria, epidemiology, pathogenesis, differential diagnosis, and treatment.
STUDY DESIGN/SETTING
A systematic literature review of cervicogenic headache was performed.
METHODS
Three computerized medical databases (Medline, Cumulative Index to Nursing and Allied Health Literature [CINAHL], Mantis) were searched for the terms "cervicogenic" and "headache." After cross-referencing, we retrieved 164 unique citations; 48 citations were added from other sources, for a total of 212 citations, although all were not used.
RESULTS
Hilton described the concept of headaches originating from the cervical spine in 1860. In 1983 Sjaastad introduced the term "cervicogenic headache" (CGH). Diagnostic criteria have been established by several expert groups, with agreement that these headaches start in the neck or occipital region and are associated with tenderness of cervical paraspinal tissues. Prevalence estimates range from 0.4% to 2.5% of the general population to 15% to 20% of patients with chronic headaches. CGH affects patients with a mean age of 42.9 years, has a 4:1 female disposition, and tends to be chronic. Almost any pathology affecting the cervical spine has been implicated in the genesis of CGH as a result of convergence of sensory input from the cervical structures within the spinal nucleus of the trigeminal nerve. The main differential diagnoses are tension type headache and migraine headache, with considerable overlap in symptoms and findings between these conditions. No specific pathology has been noted on imaging or diagnostic studies which correlates with CGH. CGH seems unresponsive to common headache medication. Small, noncontrolled case series have reported moderate success with surgery and injections. A few randomized controlled trials and a number of case series support the use of cervical manipulation, transcutaneous electrical nerve stimulation, and botulinum toxin injection.
CONCLUSIONS
There remains considerable controversy and confusion on all matters pertaining to the topic of CGH. However, the amount of interest in the topic is growing, and it is anticipated that further research will help to clarify the theory, diagnosis, and treatment options for patients with CGH. Until then, it is essential that clinicians maintain an open, cautious, and critical approach to the literature on cervicogenic headaches.
Topics: Cervical Vertebrae; Headache; Humans; Spinal Diseases
PubMed: 14588366
DOI: 10.1016/s1529-9430(01)00024-9 -
BMC Anesthesiology Mar 2024Spinal surgeries are accompanied by excessive pain due to extensive dissection and muscle retraction during the procedure. Thoracolumbar interfascial plane (TLIP) blocks...
Thoracolumbar Interfascial Plane (TLIP) block verses other paraspinal fascial plane blocks and local infiltration for enhanced pain control after spine surgery: a systematic review.
Spinal surgeries are accompanied by excessive pain due to extensive dissection and muscle retraction during the procedure. Thoracolumbar interfascial plane (TLIP) blocks for spinal surgeries are a recent addition to regional anesthesia to improve postoperative pain management. When performing a classical TLIP (cTLIP) block, anesthetics are injected between the muscle (m.) multifidus and m. longissimus. During a modified TLIP (mTLIP) block, anesthetics are injected between the m. longissimus and m. iliocostalis instead. Our systematic review provides a comprehensive evaluation of the effectiveness of TLIP blocks in improving postoperative outcomes in spinal surgery through an analysis of randomized controlled trials (RCTs).We conducted a systematic review based on the PRISMA guidelines using PubMed and Scopus databases. Inclusion criteria required studies to be RCTs in English that used TLIP blocks during spinal surgery and report both outcome measures. Outcome data includes postoperative opioid consumption and pain.A total of 17 RCTs were included. The use of a TLIP block significantly decreases postoperative opioid use and pain compared to using general anesthesia (GA) plus 0.9% saline with no increase in complications. There were mixed outcomes when compared against wound infiltration with local anesthesia. When compared with erector spinae plane blocks (ESPB), TLIP blocks often decreased analgesic use, however, this did not always translate to decreased pain. The cTLIP and mTLP block methods had comparable postoperative outcomes but the mTLIP block had a significantly higher percentage of one-time block success.The accumulation of the current literature demonstrates that TLIP blocks are superior to non-block procedures in terms of analgesia requirements and reported pain throughout the hospitalization in patients who underwent spinal surgery. The various levels of success seen with wound infiltration and ESPB could be due to the nature of the different spinal procedures. For example, studies that saw superiority with TLIP blocks included fusion surgeries which is a more invasive procedure resulting in increased postoperative pain compared to discectomies.The results of our systematic review include moderate-quality evidence that show TLIP blocks provide effective pain control after spinal surgery. Although, the application of mTLIP blocks is more successful, more studies are needed to confirm that superiority of mTLIP over cTLIP blocks. Additionally, further high-quality research is needed to verify the potential benefit of TLIP blocks as a common practice for spinal surgeries.
Topics: Humans; Analgesics, Opioid; Pain Management; Neurosurgical Procedures; Pain, Postoperative; Anesthetics
PubMed: 38539065
DOI: 10.1186/s12871-024-02500-1 -
ANZ Journal of Surgery Sep 2018While still a rare entity, acute lumbar paraspinal compartment syndrome has an increasing incidence. Similar to other compartment syndromes, acute lumbar paraspinal...
While still a rare entity, acute lumbar paraspinal compartment syndrome has an increasing incidence. Similar to other compartment syndromes, acute lumbar paraspinal compartment syndrome is defined by raised pressure within a closed fibro-osseous space, limiting tissue perfusion within that space. The resultant tissue ischaemia presents as acute pain, and if left untreated, it may result in permanent tissue damage. A literature search of 'paraspinal compartment syndrome' revealed 21 articles. The details from a case encountered by the authors are also included. A common data set was extracted, focusing on demographics, aetiology, clinical features, management and outcomes. There are 23 reported cases of acute compartment syndrome. These are typically caused by weight-lifting exercises, but may also result from other exercises, direct trauma or non-spinal surgery. Pain, tenderness and paraspinal paraesthesia are key clinical findings. Serum creatine kinase, magnetic resonance imaging and intracompartment pressure measurement confirm the diagnosis. Half of the reported cases have been managed with surgical fasciotomy, and these patients have all had good outcomes relative to those managed with conservative measures with or without hyperbaric oxygen therapy. These good outcomes were despite significant delays to operative intervention. The diagnostic uncertainty and subsequent delay to fasciotomy result from the rarity of this disease entity, and a high level of suspicion is recommended in the appropriate setting. This is particularly true in light of the current popularity of extreme weight lifting in non-professional athletes. Operative intervention is strongly recommended in all cases based on the available evidence.
Topics: Acute Disease; Acute Kidney Injury; Adolescent; Adult; Aged; Compartment Syndromes; Creatine Kinase; Fasciotomy; Female; Humans; Incidence; Ischemia; Lumbosacral Region; Magnetic Resonance Imaging; Male; Middle Aged; Myoglobin; Rhabdomyolysis; Treatment Outcome; Young Adult
PubMed: 29316189
DOI: 10.1111/ans.14342 -
European Spine Journal : Official... Jun 2020Low back pain (LBP) resulting from degenerative lumbar spine disease is a leading contributor to global disability. Changes in the morphology of the lumbar multifidus... (Meta-Analysis)
Meta-Analysis Review
Does pre-operative multifidus morphology on MRI predict clinical outcomes in adults following surgical treatment for degenerative lumbar spine disease? A systematic review.
AIM
Low back pain (LBP) resulting from degenerative lumbar spine disease is a leading contributor to global disability. Changes in the morphology of the lumbar multifidus muscle on magnetic-resonance imaging (MRI) are associated with worse LBP and disability, but the association between multifidus morphology and post-operative outcomes is not known. The purpose of this systematic review is to examine the relationship between pre-operative multifidus morphology and post-operative changes in pain and disability.
METHODS
We performed a systematic search using the Cochrane Library, EMBASE, MEDLINE, CINAHL and Scopus databases covering the period from January 1946 to January 2018. The literature was searched and assessed by independent reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. All relevant papers were assessed for risk of bias according to the Quality in Prognosis Studies tool.
RESULTS
The initial search yielded 436 studies, of which 6 studies were included in the analysis. Four studies were at a low risk of bias. These studies included a total of 873 patients undergoing spinal surgery. An association between low fat infiltration and greater improvement in LBP and disability following surgery was identified. There was insufficient evidence to identify a relationship between cross-sectional area (CSA) and LBP or disability.
CONCLUSIONS
This systematic review found evidence for an association between low multifidus fat infiltration on MRI at baseline and greater reductions in measures of LBP and disability following surgical treatment. There is also limited evidence for an association between larger pre-operative multifidus CSA and improvements in disability, but not pain. The findings of this review should be interpreted with caution due to the small quantity of the available literature.
Topics: Adult; Humans; Low Back Pain; Lumbar Vertebrae; Lumbosacral Region; Magnetic Resonance Imaging; Paraspinal Muscles; Spinal Diseases
PubMed: 32328791
DOI: 10.1007/s00586-020-06423-6 -
Journal of Clinical Anesthesia Nov 2020The erector spinae plane block (ESPB) is a newly defined regional anesthesia technique first introduced in 2016. The aim of this study is to determine its analgesic... (Meta-Analysis)
Meta-Analysis Review
STUDY OBJECTIVE
The erector spinae plane block (ESPB) is a newly defined regional anesthesia technique first introduced in 2016. The aim of this study is to determine its analgesic efficacy compared with non-block care and thoracic paravertebral block (TPVB).
DESIGN
We systematically searched PubMed, Web of Science citation index, Embase, the Cochrane Library, Google Scholar, and ClinicalTrials.gov register searched up to March 2020. We conducted a meta-analysis of randomized controlled trials (RCTs) that compared an ESPB to non-block care or TPVB for postoperative analgesia in breast and thoracic surgery patients. Primary outcome was 24-hour postoperative opioid consumption. Risk of bias was assessed using Cochrane methodology.
RESULTS
14 RCTs that comprised 1018 patients were included. Seven trials involved thoracic surgery patients and seven included breast surgery patients. Meta-analysis revealed that ESPB significantly reduced 24-hour opioid consumption compared with the non-block groups (-10.5 mg; 95% CI: -16.49 to -3.81; p = 0.002; I = 99%). Similarly, the finding was consistent in subgroup analysis between the breast surgery (-7.75 mg; 95%CI -13.98 to -1.51; p = 0.01; I = 97%) and thoracic surgery (-14.81 mg; 95%CI -21.18 to -8.44; p < 0.001; I = 96%) subgroups. The ESPB significantly reduced pain scores at rest or movement at various time points postoperatively compared with non-block group, and reduced the rate of postoperative nausea and vomiting (OR 0.48; 95%CI 0.27 to 0.86; p = 0.01; I = 0%). In contrast, there were no significative differences reported in any of the outcomes for ESPB versus TPVB strata.
CONCLUSIONS
ESPB improved analgesic efficacy in breast and thoracic surgery patients compared with non-block care. Furthermore, current literature supported the ESPB offered comparable analgesic efficacy to a TPVB.
Topics: Analgesia; Humans; Nerve Block; Pain, Postoperative; Paraspinal Muscles; Thoracic Surgery
PubMed: 32502778
DOI: 10.1016/j.jclinane.2020.109900 -
The Spine Journal : Official Journal of... Jul 2022Chronic spinal pain is one the most common musculoskeletal disorders. Previous studies have observed microscopic structural changes in the spinal extensor muscles in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND CONTEXT
Chronic spinal pain is one the most common musculoskeletal disorders. Previous studies have observed microscopic structural changes in the spinal extensor muscles in people with chronic spinal pain. This systematic review synthesizes and analyzes all the existing evidence of muscle microscopic changes in people with chronic spinal pain.
PURPOSE
To assess the microscopy of spinal extensor muscles including the fiber type composition, the area occupied by fiber types, fiber size/cross sectional area (CSA), and narrow diameter (ND) in people with and without chronic spinal pain. Further, to compare these outcome measures across different regions of the spine in people with chronic neck, thoracic and low back pain.
STUDY DESIGN
Systematic review with meta-analysis.
METHODS
MEDLINE (Ovid Interface), Embase, PubMed, CINAHL Plus, and Web of Science were searched from inception to October 2020. Key journals, conference proceedings, grey literature and hand searching of reference lists from eligible studies were also searched. Two independent reviewers were involved in the selection process. Only studies examining the muscle microscopy of the spinal extensor muscles (erector spinae [ES] and/or multifidus [MF]) between people with and without chronic spinal pain were selected. The risk of bias from the studies was assessed using modified Newcastle Ottawa Scale and the level of evidence was established using the GRADE approach. Data were synthesized based on homogeneity on the methodology and outcome measures of the studies for ES and MF muscles and only four studies were eligible for analysis.
RESULTS
All the five studies included were related to chronic low back pain (CLBP). Meta-analysis (inverse variance method for random effect to calculate mean difference and 95% CI) was performed for the ES fiber type composition by numbers for both type I and type II fibers (I=43% and 0% respectively indicating homogeneity of studies) and showed no difference between the people with and without CLBP with an overall effect estimate Z= 1.49 (p=.14) and Z=1.06 (p=.29) respectively. Meta-analysis was performed for ES fiber CSA for both type I and type II fibers (I=0 for both) and showed no difference between people with and without CLBP with an overall effect estimate Z=0.08 (p=.43) and Z=0.75 (p=.45) respectively. Analysis was not performed for ES area occupied by fiber types and ND due to heterogeneity of studies and lack of evidence respectively. Similarly, meta-analysis was not performed for MF fiber type composition by numbers due to heterogeneity of studies. MF analysis for area occupied by fiber type, fiber CSA and ND did not yield sufficient evidence.
CONCLUSIONS
For the ES muscle, there was no difference in fiber type composition and fiber CSA between people with and without CLBP and no conclusions could be drawn for ND for the ES. For the MF, no conclusions could be drawn for any of the muscle microscopy outcome measures. Overall, the quality of evidence is very low and there is very low evidence that there are no differences in microscopic muscle features between people with and without CLBP.
Topics: Chronic Pain; Humans; Low Back Pain; Paraspinal Muscles; Spine
PubMed: 35134540
DOI: 10.1016/j.spinee.2022.01.023 -
World Neurosurgery Feb 2022Patients undergoing spine surgery may experience substantial postoperative pain. The aim of this systematic review is to examine the clinical efficacy of a newly... (Review)
Review
BACKGROUND
Patients undergoing spine surgery may experience substantial postoperative pain. The aim of this systematic review is to examine the clinical efficacy of a newly introduced regional anesthetic block, the erector spinae plane block (ESPB), for adults undergoing posterior spine surgeries.
METHODS
A formal systematic database search was conducted in PubMed, Ovid Medline, Embase, Cochrane library, and Google Scholar for randomized controlled trials comparing ESPB with control or placebo.
RESULTS
Our systematic review demonstrates a reduction of postoperative pain and opioid consumption in patients who had ESPB compared with control groups for lumbar spine surgery. However, the effect obtained revealed only a short-term benefit.
CONCLUSIONS
Current evidence is insufficient to support the widespread use of ESPB for spine surgery. More studies are warranted to confirm or refute its role in clinical practice.
Topics: Adult; Anesthetics, Local; Humans; Nerve Block; Pain, Postoperative; Paraspinal Muscles; Randomized Controlled Trials as Topic
PubMed: 34767990
DOI: 10.1016/j.wneu.2021.11.005 -
Paediatric Anaesthesia Oct 2021The erector spinae plane block is a novel regional anesthetic technique that is gaining popularity in pediatrics. However, the efficacy of erector spinae plane block in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The erector spinae plane block is a novel regional anesthetic technique that is gaining popularity in pediatrics. However, the efficacy of erector spinae plane block in children is unclear. The aim of the systematic review and meta-analysis was to investigate effects of erector spinae plane block on postoperative pain relief in children.
METHODS
We searched MEDLINE, Cochrane Library, EMBASE, China National Knowledge Infrastructure, and Wan fang databases for randomized controlled trials that compared erector spinae plane block with no block or other types of block in pediatric patients undergoing surgeries. The primary outcomes were pain intensity at rest within 24 h postoperatively and the number of patients requiring rescue analgesics. Data were analyzed using the fixed- or random-effects model, depending on whether the heterogeneity tested by the I statistic was >30%. We assessed the quality of evidence for the outcomes using the Grading of Recommendations, Assessment, Development, and Evaluation method.
RESULTS
Seven randomized controlled trials involving 379 patients were reviewed. Compared with no block, erector spinae plane block slightly reduced the pain scores at 0 h (standardized mean difference [SMD]: -1.07; 95% confidence interval [CI]: -1.60 to -0.54; I = 52%), 6 h (SMD: -0.82; 95% CI: -1.39 to -0.25; I = 79%) postoperatively at rest and significantly reduced the need for rescue analgesics (odds ratio 0.09; 95% CI: 0.04 to 0.21; I = 16%). One trial demonstrated the analgesic effect of erector spinae plane block was similar to a quadratus lumborum block, while another trial demonstrated the analgesic effect of ESPB was superior to an ilioinguinal nerve block.
CONCLUSIONS
This review provides low-quality evidence that erector spinae plane block exhibits superior analgesia compared to no block in children. Due to the limited data, evidence regarding the comparison with other regional blocks remains unclear. Future large-sized and well-designed randomized controlled trials are needed.
Topics: Anesthesia, Conduction; Child; Humans; Nerve Block; Pain, Postoperative; Paraspinal Muscles; Randomized Controlled Trials as Topic
PubMed: 34270146
DOI: 10.1111/pan.14255